Health Sector Reform and Business Opportunity in Japanese Health

Health Sector Reform
and
Business Opportunity in Japanese Health Care Market
Akiko Ishihara
BDD, SIPO S‐FWBC
Associate Professor, Kumamoto Univ.
[email protected]
Basic Information of Japanese Health Care System
1.Health Care Provider:90% private, 10% public
Free Access(People want to go to “Big Hospitals”)
2.Health Insurance:
2‐1. 100% of population (in the past),now the number of uninsured is increasing
2‐2.Several types of Health Insurance:
<under 74>
・Health Insurance Organization(Each company or a group of company has it for their workers)
・National Health Insurance(other than the above)
<over 75>
・Health Insurance for people over 75
Basic Information of Japanese Health Care System
2‐3. Self‐payment ratio
<under 74>
30% out of pocket, 70% from insurance(general population) <over 75>
10% out of pocket, limitation of self payment is 3. Long‐term Care Insurance（National)
・people over 40 should contribute(pay)
・over 65 and certified people can have benefit
Basic Information of Japanese Health Care System
2‐3. Self‐payment ratio
<under 74>
30% out of pocket, 70% from insurance(general population) <over 75>
10% out of pocket, limitation of self payment is 3. Long‐term Care Insurance（National)
・people over 40 should contribute(pay)
・over 65 and certified people can have benefit
What we should resolve?
1.Problems caused by Aging
2.“Iryo‐houkai”医療崩壊（Collapse of Health Care)
Medical doctors’ withdrawal from specialties, areas of hard work, high risk of sued, and low income(such as obstetrics, pedeatrics, emergency care, rural areas, etc.) In many towns, they are suffering from shortage of medeical doctors and hospitals.
Many conflicts in Hospitals.
Life Expectancy
85
85
NO.1 of the world in 1984
83
Male
81
83
81
77
77
75
75
73
73
71
71
69
69
67
67
65
65
Ｃ T
Hasegawa
19
6
19 2
6
19 5
6
19 8
7
19 1
7
19 4
7
19 7
8
19 0
8
19 3
8
19 6
8
19 9
9
19 2
95
79
19
63
19
67
19
71
19
75
19
79
19
83
19
87
19
91
19
95
79
Female
OECD Health Data
Australia
Austria
Belgium
Canada
Czech Republic
Denmark
Finland
France
Germany
Greece
Hungary
Iceland
Ireland
Italy
Japan
Korea
Luxembourg
Mexico
Netherlands
New Zealand
Norway
Poland
Portugal
Spain
Sweden
Switzerland
Turkey
United Kingdom
United States
Population Pyramid
Year:2000
age
Year:2050
http://www.ipss.go.jp/
Population Pyramid
Sendai City 2005
中年太
http://www.ipss.go.jp/
Population Pyramid Sendai City 2025
http://www.ipss.go.jp/
Population Pyramid
Sendai City 2050
http://www.ipss.go.jp/
Population Pyramid
Naruko Town(Miyagi Pref.) 2005
中年太
http://www.ipss.go.jp/
Population Pyramid
Naruko Town(Miyagi Pref.) 2025
人口ピラミッド
http://www.ipss.go.jp/
Population Pyramid
Naruko Town(Miyagi Pref.) 2050
http://www.ipss.go.jp/
Health
HealthCare
CareExpenditure
Expenditure
○我が国の国民医療費は国民所得を上回る伸びを示している。
（兆円）
40
25.8 27.0
35
30
25
（％）
National Health Care cost by GDP（％）
6.9
7.2
31.5 32.1
31.1
31.0
30.7
30.1
29.6
8.
6
8.
7
28.5 28.9 7.9
8.1
8.9
8.8
7.5
7.6
9
8
8.4
6.1
7
Health Care cost
16.0
6
5
20
15
10
5
4
Health care cost for the elderly
25.4%
31.6%
8.2
33.1%
8.9
34.2%
9.7
10.3
35.5%
10.9
36.8%
11.8
38.4%
11.2
37.2%
11.7
37.5%
11.7
37.9%
11.7
36.9%
2
4.1
・食事療養費
制度の創設
0
60
6
・被用者本人 ・診療報酬 ・
・老人一部負担金
２割負担へ 薬価等の改定
の 物価スライド実
▲１．３％
引上げ
施
・外来薬剤
一部負担導
入
7
3
11.6
36.1%
8
9
10
11
・介護保険制
度 が施行
・高齢者１割負
担導入
12
年度
1
13
・診療報酬 ・・被用者本 ・診療報酬 ・
薬価等の改定 人
薬価等の改定
▲２．７％
▲１．０％
３割負担へ
・高齢者１割 引上げ
負担徹底
14
15
16
0
Challenge in Health Policy for Super Aging Society
1.Resolving Expanding Health care cost & Welfare cost
2. Responding to Needs of the Elderly
*High QOL (Healthy Life Expectancy)
*Co‐morbidity
Challenge in Health Policy for Collapse of Health Care
1.How to satisfy the medical care needs in areas where they are suffering the shortage of medical doctors?
2.How to recover the trust relationship between medical providers and consumers
Health Sector Reform in 2006
Overview of Health Sector Reform
１．Safe and trustworthy Health Care and Focus on
Prevention
（１）Health care system for Patient oriented, high quality of
medical care
・Choice of health care providers by users based on information
・Functional Differentiation of Medical Providers and continuity of
treatment: the New Regional Health Plan
・Higher QOL by More Focus on Home Care(de-institutionalization)
・Resolving the uneven distribution of medical doctors especially
pediatrician, etc
（２）New measure for life style-related diseases prevention
・Metabolic Syndrome prevention
Facilitate social movement of prevention from Metabolic
Syndrome
・to clarify the role of health insurance organization(the New
Health
Check for Metabo. and intervention cf. Disease Management)
・Enhancement of Regional Health Promotion Plan
２．The New Plan of Cost containment
（１）legislation of Prefectures’ mandatory “Plan for Health Care
Cost Containment” （ cost containment by life style-related diseases
prevention, shortening average length of stay)
（２）Revision of Public Health Insurance
３．The New Medical Health Insurance to survive
super aging society
（１）Separating public health insurance for people over 75 from
national health insurance for general population
（２）Restructuring and consolidation of unit of public health/longterm care insurance(from municipality into prefecture)
【the 5th Medical Service Act
reviced in 2006】
①Publicity of all medical providers
(Prefectures’ responsibility)
②the New Regional Health Plan(4+5,
objective management)
③Resolving the uneven distribution of
Medical Doctors among areas and
specialties
④Promoting Patient Safety
⑤Improving Quality of Health Care Workers
⑥Reform of legislation of medical
corporation
【Revision of Legislation of National
Health Insurance】
①Health care cost containment
・ legislation of Prefectures’ mandatory
“Plan for Health Care Cost Containment”
・Health insurance organizations’
mandatory give their insured over 40
Health Check and intervention for Metabo. cf.
Disease Management
・Revision of Public Health Insurance
・Hospitals for nursing care abolish by
revision of the medical fee scheme
② Separating public health insurance for
people over 75 from national health insurance
for general population
③ Restructuring and consolidation of unit of
public health/long-term care insurance(from
21
municipality into prefecture)
Some service(business) opportunities in health care in Japan
1.Metabolic Syndrome Health Check and intervention
different from disease management
Health coach
2. Call center triage
3. Conflict Management
4. Consulting for improvement of Health Care outcome
Some service(business) opportunities in health care in Japan
1.Mandatory Metabolic Syndrome Health Check and
intervention by the Health Insurance Organization
(with punishment system: HIOs should pay more money
for the government to help public health insurance(mainly for
the elderly))
Disease Management Business, Health Coach
・difference from disease management
cost
問題
１．資源の集中投下できない
２．医療に行く人が増えて医療費増える
（医師から金とる）
３．保険者（特に）は金がなく、しかもコ
スト意識が低い
severity
Some service(business) opportunities in health care in Japan
Call center triage （Mawell model)
・very high needs!! Because of Aging and Collapse of
Health Care,,,(but for foreign companies to enter the
market?)
・In Japanese context, contact center concept is applicable
not for daily health care but for emergency healthcare.
・In daily health care, people want to see medical doctors
directly, so they won’t call to nurses(We have FREE
ACCESSS to Big Hospitals, the elderly has enough time to
wait for and to see doctors)
・For emergency or health care needs at night and in
holidays,,,too much patient for hostpitals and too much call
amburance cars(Amburance care is free) abuse of
amburance car use(My cat has fever!! I have athlete's foot)
・
Some service(business) opportunities in health care in Japan
<Call center triage （Mawell model)>
●Existing Health Call center
<public>
・acute call for children #8000(purpose triage)
・call center for guidance for holidays(no triage, limited
which hospitals/clinics are open)
・Call center for triage (ex. Model trial in some areas by
ministry of Fire) already running TOKYO, YOKOHAMA
<private>
・Health advice call center for insured of HIO
(Advise for Acute, Disease management, mental health)
<othes>
・call for prevention from suicide(mental health)
Some service(business) opportunities in health care in Japan
<Call center triage （Mawell model)>
●Walls for future collaboration between F and J
Guideline for advise
Legislation (diagnosis is limited to MD)
HER terrible in Japan
Conflict of triage direction and price direction
Some service(business) opportunities in health care in Japan
<Conflict Management>
including communication training
<Consulting for improvement of Health Care outcome>
Responding to heatlh sector reform
Thank you very much
Kiitos
Arigatou ozaimasita.
More collaboration between Finland and Japan
for the wonderful future of my generation